PLOS ONE · 8 authors, 5 centres
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This cross-sectional study in Nigeria found that protein energy wasting (PEW) affects 33.3% of pre-dialysis chronic kidney disease (CKD) patients. PEW was significantly associated with middle age, depression, and advanced CKD stage. The findings highlight the need for routine nutritional and mental health assessment in CKD patients to enable early intervention.
**Background:** Protein energy wasting (PEW) is a common complication in chronic kidney disease (CKD) characterized by loss of muscle and fat due to metabolic and nutritional alterations. It worsens frailty, sarcopenia, and debility. Despite its clinical importance, PEW is not routinely assessed in CKD management in Nigeria. This study aimed to determine the prevalence of PEW and its associated factors in pre-dialysis CKD patients in Benin City, Nigeria.
**Methods:** This cross-sectional study was conducted at the University of Benin Teaching Hospital from October 2016 to November 2017. A total of 250 pre-dialysis CKD patients (stages 3-5) and 125 age- and sex-matched healthy controls were recruited. PEW was diagnosed using a combination of at least two of the following criteria: body mass index (BMI) <23 kg/m², serum albumin <3.8 g/dL, and subjective global assessment (SGA) score of B or C (indicating malnutrition). Depression was assessed using the Hamilton Depression Rating Scale. Data were analyzed using SPSS version 21.0; logistic regression identified predictors of PEW.
**Key Results:** The mean age of CKD patients was 52.3±16.0 years; 53.6% were female. The most common causes of CKD were hypertension (33.2%), chronic glomerulonephritis (26.8%), and diabetes mellitus (26.0%). The prevalence of low BMI, hypoalbuminaemia, and malnutrition by SGA in CKD patients was 42.4%, 62.0%, and 74.8%, respectively. The overall prevalence of PEW was 33.3% (83/250); none of the controls had PEW. On bivariate analysis, PEW was significantly associated with age (p<0.001), income (p=0.001), marital status (p=0.022), CKD duration (p=0.001), CKD stage (p<0.001), anorexia (p<0.001), and depression (p=0.002). On multiple logistic regression, independent predictors of PEW were: middle age (45-64 years) (adjusted odds ratio [AOR] 12.50; 95% CI 3.42–45.00; p<0.001), depression (AOR 2.34; 95% CI 1.02–5.40; p=0.046), and CKD stage 5 (AOR 12.83; 95% CI 3.53–46.60; p<0.001).
**Clinical Implications:** PEW is common in pre-dialysis CKD patients in Nigeria, affecting one in three patients. The strong association with depression and advanced CKD stage underscores the need for routine screening for both nutritional status and mental health in CKD patients. Early identification and treatment of depression, along with nutritional interventions (dietary counselling, oral supplementation, exercise), may help prevent PEW and improve outcomes. The study highlights a gap in current practice and calls for integrating PEW assessment into standard CKD care, especially in resource-limited settings.